A core requirement for health plans across the country is measuring and reporting on quality metrics. However, directly influencing those metrics can often be a struggle. Improving quality metrics is directly correlated with identifying and addressing gaps in care. By deploying a proactive, year-round strategy that aligns data analytics with a focused approach for addressing gaps in care, your organization can turn routine quality measurement and reporting activities into a true strategic advantage by ensuring that quality measurably improves across key metrics.
Gaps in care: clinical perspective
A critical component of improving quality scores and outcomes is recognizing the challenges faced by your physician network in closing gaps in care and engaging with providers about building a quality improvement strategy. Physicians and staff spend an average of 15 hours per week closing gaps in care and satisfying quality measures, while provider organizations spend an average of $40,000 per physician per year to satisfy their quality initiatives—and that cost is expected to go up due to the prevalence of risk-based contracts. Often, providers are not well equipped to meet the primary driver of quality: closing gaps in care.
There are three foundational pillars that make up the strategy for providers to follow to improve quality: patient engagement, quality scorecards, and population health management.
Using claims data is the easiest way to identify patients who have not been seen before the measurement period ends. Providers can create patient lists in early September to have patients come in by the end of the measurement year to close as many gaps as possible. From there, staff can perform immunizations, order lab tests that were missed, and most importantly, schedule patients for face-to-face visits with their primary care provider. The most meaningful patient engagement occurs in the exam room. Face-to-face contact is the number one tool to close gaps in care, outranking mobile apps, patient portals, social media, or surveys.
Timely and actionable quality scorecards also demonstrate to providers where the gaps in care are for their patients. Physicians should be engaged in how the scorecards are designed and at what intervals they should be delivered, such as monthly or quarterly.
Finally, population health analytics help providers aggregate member data, assess population risk, stratify their patients based on risk/gaps identified, identify gaps in care, engage patients based on need, and close gaps in care and improve quality.